Drug Induced Platelet Dysfunction

Aka: Drug Induced Platelet Dysfunction, Drug Induced Platelet Destruction, Drug induced Thrombocytopenia, Drug-Induced Thrombocytopenia, Thrombocytopenia caused by Medications

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II. Causes: Thrombocytopenia

  1. Chemotherapeutic agents
    1. Alkylating Agents
    2. Antimetabolites
    3. Interferon alpha
    4. Fludarabine
    5. Oxaliplatin
    6. Bleomycin
    7. Rituximab
    8. Trastuzumab
  2. Antibiotics
    1. Sulfonamides (e.g. Trimethoprim-Sulfamethoxazole or Bactrim)
    2. Penicillins
    3. Cephalosporins
    4. Rifampin
    5. Vancomycin
    6. Fluoroquinolones
    7. Linezolid
    8. Ganciclovir
  3. Cardiovascular Agents
    1. Captopril
    2. Thiazide Diuretics (Hydrochlorothiazide, Chlorthalidone)
    3. Spironolactone
    4. Furosemide (Lasix)
    5. Amiodarone
    6. Abciximab (ReoPro)
    7. Glycoprotein IIB/IIIA Inhibitor (Eptifibatide or Integrilin, Tirofiban)
    8. Digoxin
    9. Methyldopa
    10. Procainamide
    11. Cinchona alkaloids (Quinidine, Quinine, Tonic Water)
  4. H2 Antagonists
    1. Cimetidine (Tagamet)
    2. Ranitidine (Zantac)
  5. Neurologic agents (esp. antiepileptic agents)
    1. Phenytoin (Dilantin)
    2. Valproic Acid (Depakene)
    3. Lamotrigine (Lamictal)
    4. Carbamazepine (Tegretol)
    5. Levetiracetam (Keppra)
  6. Psychiatric Agents
    1. Barbiturates
    2. Benzodiazepines (Diazepam, Lorazepam)
    3. Chlorpromazine
    4. Citalopram
    5. Haloperidol
    6. Olanzapine (Zyprexa)
    7. Risperidone (Risperdal)
  7. Rheumatologic Agents
    1. Acetaminophen (autoimmune mechanism)
    2. NSAIDs (e.g. Ibuprofen, Naproxen, Indomethacin, piroxicam, diclofenac)
    3. Gold Salts
    4. Sulfasalazine (Azulfidine)
  8. Endocrine Agents
    1. Estrogens
    2. Propylthiouracil
  9. Herbals
    1. Cranberry Juice
    2. Jui herbal tea
    3. Lupinus termis bean
    4. Cow's Milk
    5. Tahini (sesame seed paste)
    6. Other Herbals may also be causes (e.g. chromium, Echinacea, hypericum, nicotinamide, Cupressus funebris)
  10. Immunizations
    1. MMR Vaccine
    2. Varicella Vaccine
    3. H1N1 Influenza Vaccine
  11. Miscellanous Agents
    1. See Drug-Induced Thrombotic Microangiopathic Anemia
    2. Chronic Alcohol Abuse
    3. Quinine
    4. Heparin Induced Thrombocytopenia
      1. Occur in 5% of patients on >5 days Heparin
      2. In vivo Platelet aggregation due to immune complexes against Platelet factor 4 (PF4) and Heparin

III. Causes: Platelet impaired function

  1. Common causes
    1. Consider agents that affect coagulation (Heparin, Warfarin)
    2. Aspirin
    3. Nonsteroidal Antiinflammatory Drugs (NSAIDs)
    4. Clopidogrel (Plavix)
  2. Other causes
    1. Antidepressants
      1. Tricyclic Antidepressants
      2. Selective Serotonin Reuptake Inhibitors
    2. Antihistamines
      1. Azatadine
      2. Brompheniramine
      3. Clemastine fumarate
    3. Clofibrate
    4. Dipyridamole
    5. Furosemide (Lasix)
    6. Ginkgo Biloba
    7. Nitrofurantoin (Furadantin)
    8. Propranolol
    9. Sulfinpyrazone

IV. Course

  1. Platelet Count rarely falls below 20,000/uL in Drug induced Thrombocytopenia
  2. Onset within 3 to 10 days of starting the medication
  3. Expect recovery in 7-14 days after discontinuation of medication
    1. Consider alternative Thrombocytopenia Causes when Thrombocytopenia persists after stopping suspected medication

V. Management

  1. Discontinue offending agent and recheck Platelet Count in 1 week
  2. Consider drug-specific antiplatelet Antibody testing when patient is on multiple medications that may cause Thrombocytopenia
  3. See Thrombocytopenia
  4. See Thrombocytopenia Causes

VI. Resources

  1. Platelets on the Web
    1. https://ouhsc.edu/platelets/ditp.html

VII. References

  1. Merrill and Gillen (2016) Crit Dec Emerg Med 30(3): 3-8
  2. Kenney (2009) Arch Pathol Lab Med 133(2): 309-14 [PubMed]
  3. Gauer (2022) Am Fam Physician 106(3): 288-98 [PubMed]

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Related Studies

Ontology: Thrombocytopenia due to drugs (C0340977)

Concepts Pathologic Function (T046)
SnomedCT 191322006
English Thrombocytopenia (due to): drugs, Thrombocytopenia due to drugs, Thrombocytopenia due to drugs (disorder), drugs; thrombocytopenia, thrombocytopenia; drugs
Dutch geneesmiddel; trombocytopenie, trombocytopenie; geneesmiddelen
Spanish trombocitopenia medicamentosa (trastorno), trombocitopenia medicamentosa, trombocitopenia por fármacos
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Drug Induced Thrombocytopenia (C2063616)

Definition (NCI) Thrombocytopenia caused by ingested or injected drugs. It may be the result of decreased platelet production due to bone marrow suppression or increased rate of platelet destruction.
Concepts Disease or Syndrome (T047)
English drug-induced thrombocytopenia (diagnosis), drug-induced thrombocytopenia, Drug Induced Thrombocytopenia, DITP, Drug-Induced Immune Thrombocytopenia
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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